Sequential antibiotic therapy against Helicobacter pylori may result in a better eradication rate than standard triple-drug therapy, an Italian randomised controlled trial has shown. A total of 295 patients with proven H. pylori infection underwent endoscopy, biopsy, and bacterial culture of biopsy specimens. One group of patients received a 10-day sequential regimen of pantoprazole, amoxycillin, clarithromycin, and tinidazole. The other group was given standard 10-day therapy of pantoprazole, clarithromycin, and amoxycillin, each given twice daily. After treatment, patients underwent a second diagnostic 13C-urea breath test to detect presence of H. pylori. Sequential therapy resulted in a greater eradication rate and was significantly more effective in the treatment of clarithromycin-resistant strains.
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